Abstract
Significant extension of thyroid masses into the mediastinum has historically necessitated high-morbidity sternotomy or thoracotomy incisions during substernal thyroidectomy. This preliminary experience from a single-center, tertiary-care academic institution illustrates a combined minimally invasive robotic-assisted thoracic surgery (RATS) and transcervical approach for substernal thyroidectomy. Patients are considered for the minimally invasive approach for substantial goiter extension into the anterior and posterior mediastinum, in addition to risk factors for wound healing complications associated with sternotomy. Relative exclusion criteria include prior thoracic surgery or radiographic extrathyroidal invasion into mediastinal structures. Using the Intuitive Surgical da Vinci Xi platform, right-sided RATS mobilization of the mediastinal component is immediately followed by transcervical excision. The robotic approach enables precise identification and dissection of critical neurovascular and aerodigestive structures, thereby facilitating safe transcervical delivery. Two procedures utilizing this approach were completed without complications. By avoiding sternotomy, both patients were discharged home following abbreviated inpatient stays of just 2 days. Robotic-assisted thoracic surgery represents a promising alternative to traditional invasive approaches for substernal thyroidectomy, preliminarily showing safety and feasibility, and the potential to reduce morbidity and improve recovery times.